Access Healthcare started as a plan to directly connect the health care users with health care providers and offer:
- Quality health care with the right providers in your community
- Improved service to employees and their families
- Cost transparency and cost control for both employers and employees
The program is offered as an alternative to the fully insured business model and provides a basis through partial self-funding with reinsurance agreements to establish direct contracting with appropriate quality providers at reduced prices. For example, in Southern California Keck Medicine of USC, rated 16th in the nation in quality health care by U.S. News & World Report, would be an available provider to your employees. Costco pharmacies would be your pharmacy benefit manager (PBM) with significantly discounted medications.
It is now a fact that many employees and their families with insurance coverage cannot afford to visit a doctor for an injury or ailment because of an annual deductible of $2,500 to $5,000. This is insurance that the employee is contributing 5% or more of their annual wages. What kind of reasonable or affordable care is this? Medical costs are now the number one reason for personal bankruptcy. Employers want to do more, but not pay more, in order to lessen the burden on their employees.
The results of an Access Healthcare program to employees are reduced deductibles, co-payments and out-of-pocket maximums to your employees. Employers establish medical reimbursement amounts that are reasonable and based upon metric procedure reporting to federal and state agencies as appropriate.
This approach is in contrast to the current insured business model wherein there is little or no support to identify high quality providers, no assistance in scheduling appointments or coordinating medical information between providers. and no guidance in selecting the best plan among offered options. Medical bills submitted are processed with errors in either coverage or payment, too little or too much.
Access Healthcare works with proactive employers to cut through the hodgepodge of current health care systems and create harmony. Employers are more motivated to find alternative financial models since the projected healthcare and pharmacy increases in costs are unsustainable to business. Areas of opportunity include:
- Self-insuring major portions of a health plan, reducing overhead of from 3% to 7%
- Telemedicine, saving the expense of a doctor’s visit for initial diagnosis or minor ailments needing a quick prescription drug or medication.
- Walk-in clinics and workplace visits for reduced cost access to primary care providerslul
- Increased emphasis on patient outcomes at reasonable expense
Major employers are seeking out direct contracting relationships with providers to improve employee access to treatment of the highest quality.
If you are an employer with 150 or more employees and wish to explore the alternatives available through Access Healthcare, please call or email us at the numbers listed in our website. You will be surprised what your plan can accomplish for you and your employees.